Trochanteric bursitis Flashcards
Trochanteric bursitis definition
Acute or chronic, lateral hip causing irritation to trochanteric bursa
(located between for moral trochanteric process, gluteus medias, and iliotibial tract)
Trochanteric bursitis Injury
Acute trauma include contusion related to direct impact during activities such as father impact sports
chronic cumulative trauma associated with activities like running that produce repetitive friction between bursa an IT band
Trochanteric bursitis contributing factors
True or functional leg length discrepancy, history of lateral hip surgery, participation in sports involving significant amount of running or contact
More common in women and active patients
Unknown ideology and sedentary individuals
Trochanteric bursitis clinical presentation
- Pain in lateral hip which may radiate to lateral aspect of thigh, low back
- Point tenderness and reproduction of pain with palpation
- Symptoms exacerbated by weight-bearing activity or direct pressure on affected area
- Pain with passive hip adduction
- Pain with resisted lateral (external) rotation, abduction, and extension
- Patient may complain of pain related weakness in affected extremity, sleep disturbance one roll onto affected side, pain while walking upstairs
Trochanteric bursitis diagnosis
MRI, diagnostic ultrasound - to differentiate from gluteus medius tendinitis
X-ray to rule out bony pathology and assess leg length discrepancies
Medical history and physical exam to rule out similar diagnosis such as sciatic pain, IT band syndrome, tomorrow had a vascular necrosis
Patient symptom history and physical exam findings
Trochanteric bursitis management
Medication- anti-inflammatory or anesthetic agents used alone or in combination for injection of trochanteric bursa, many patients requiring multiple injections in combination with conservative interventions for full symptom resolution
Surgical interventions uncommon
Physical therapy emphasize stretching of IT band, tensor fascia latte, lateral hip rotators, quadriceps, hip flexors
Soft tissue massage, iontophoresis, phonophoresis, palliative interventions such as TENS
Education about stretching techniques and activity modification
Gait abnormalities should be addressed with assistive devices, orthotics, heel lifts, bracing
Athletes educated about prevention, I’m going strengthening and stretching, use of protective padding for contact sports, avoid excessive unidirectional activities
HEP rest, ice, and said, therapeutic exercise, avoid exacerbating activities that perpetuate inflammatory symptoms during recovery
Trochanteric bursitis outcome
Typically responds well to conservative interventions, should be able to return fully to prior level of function including sports
Symptom recurrence possible if patients not diligent in modifying activities and continuing with therapeutic exercise interventions
Chronic symptoms of pain, altered gait, sleep disturbances associate with rolling onto affected side
Achilles tendon rupture definition
Rupture of Achilles tendon typically 1 to 2 inches above tenderness insertion on calcaneus
Achilles tendon is largest and strongest tendon in human body connects gastrocnemius and Solias insert onto calcaneal tuberosity
Achilles tendon rupture injury
Theory that Achilles tendon undergone degenerative changes starting with hypo vascularity, impaired blood flow in combination with repetitive microtrauma causes tendon to be more susceptible to injury
Achilles tendon rupture contributing factors
Frequently when push off of weight-bearing extremity with extended knee, unexpected dorsiflexion while weight-bearing, or forceful eccentric contraction a plantar flexors
Agility sports requiring quit changing footwork such as softball, tennis, basketball, football
Poor stretching routine, tight calf muscles
improper shoes during high-risk activities, altered bio mechanics at foot such as flattened arch
Over 30 years of age higher risk for rupture secondary to decreased blood flow associated with aging
History of corticosteroid injections to tendon
Achilles rupture patient
Age 40 to 60 with no previous heel or a calf pain, commonly participates in recreational activities
More common in men that our weekend warriors
Achilles Tendon rupture clinical presentation
Swelling over distal tendon, palpable defect in tendon above calcaneal tuberosity, pain and weakness with plantar flexion
Patient may have heard snap or pop during injury associated with severe pain
Patient unable to stand on toes, will not demonstrate passive plantar flexion in prone
Positive Thompson test
Complete rupture causes palpable gap in tendon prior to insertion
Achilles tendon rupture diagnosis
Imaging: X-ray to rule out avulsion fracture
MRI to locate location and severity of tear or rupture
Patient history
Positive Thompson’s test
Physical exam and palpation revealing discontinuity of tendon
O’Brien needle test
Achilles tendon rupture Management
Physician determines course of treatment based on patient’s age, activity level, comorbidities
Immobilization through casting or surgical approach for repair or reconstruction
Pharmacological only for pain NSAIDS, acetaminophen, narcotics
Nonsurgical serial casting for 10 weeks, followed by use of heel lift to decrease stress on tendon for 3 to 6 months, PT begins when cast is removed
Higher rate every rerupture 40%
Decrease risk of infection, may result in incomplete return a functional performance
Surgery cast or brace required for 6 to 8 weeks, PT same
Lower rates of re-rupture 0 to 5%
Higher rate of return to athletic activities
PT interventions same for both range of motion, stretching, Icing, assistive device training, endurance programming, gait training, strengthening, plyometrics, skill specific training
Modalities, pool therapy, other cardiovascular equipment helpful for recovery a functional motion and endurance
Achilles tendon rupture HEP
Follow post surgical protocol
Elevation and icing early in rehab
6 to 7 months of rehab focus on range of motion, strengthening, gait, endurance activities, high-level skill and sport specific tasks
